29. Testosterone Optimization Therapy

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29. Testosterone Optimization Therapy




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Introduction: The Unapologetic Truth About Testosterone

Chapter Summaries

Chapter 1 – Why are Men Losing Their Masculinity In The 21st Century?

What this Book Is

What this Book is Not

Key Takeaways

Chapter 2 – Why Optimizing Your Blood Testosterone Levels Will Transform your Physique

Testosterone Decreases Body Fat

Testosterone Increases Muscle Mass

Testosterone Improves Heart Health

Testosterone and the Brain

Testosterone and Dopamine

Testosterone and Depression

Testosterone and Memory

Testosterone Combats Alzheimer’s Disease and Improves Cognition

Testosterone Prevents Osteoporosis and Frailty

Testosterone Fights Inflammation

Key Takeaways

Chapter 3 – The Power of Testosterone to Transform Your Life

Testosterone and the Manifestation of Will

Testosterone will Improve Your Sexual Confidence with Partners

More Testosterone Equals Heightened Sex Drive and Libido

The Competitive Edge Gained From Using Testosterone

Testosterone Helps You Take Risks And Achieve Higher Social Status

Optimal Testosterone Levels Lead to Your Most Powerful and Enlightened Self

Key Takeaways

Chapter 4 -The Natural Testosterone Boosting Myth

Tongkat Ali

Tribulus Terrestris

Zinc Magnesium Aspartate (ZMA)


D-Aspartic Acid

The Only Proven Way to Raise Testosterone

Raise Libido, Raise Testosterone?

Key Takeaways

Chapter 5 – Testosterone 101: Understanding the Biological Role of Testosterone

What is Testosterone and How is It Made?

Why Do Men Stop Producing Optimal Levels of Testosterone?

Endocrine Disruption from Modern Day Societal Living

Defining Hypogonadism

Key Takeaways

Chapter 6 – Choosing When to Optimize Your Testosterone Levels

Is There an Ethical Dilemma in Choosing to Use Testosterone?

Testosterone Levels Decline with Age

Symptoms of Low Testosterone

ADAM (Androgen Deficiency in Aging Males) & AMS (Aging Males Symptoms)

Know Your Testosterone Levels, Understand Your Test Results

The Normal Range Fallacy

Vital Life Markers Necessary for TOT

How to Get Tested for Low Testosterone

Key Takeaways

Chapter 7 – Testosterone Optimization Therapy – Non Injectable Options

Bio-identical Testosterone

Creams and Gels

Natesto Nasal Gel

Oral Forms of Testosterone

Buccal Preparations

Testosterone Pellets


Key Takeaways

Chapter 8 – The Optimal TOT Protocol: Injectable Testosterone

Testosterone Undecanoate

Testosterone Propionate

Testosterone Cypionate and Testosterone Enanthate

Our Recommended TOT Protocols

The FDA and Testosterone Therapy

Choosing the Right TOT-Prescribing Physician

Vetting Your TOT Doctor

The Costs of TOT

Key Takeaways

Chapter 9 – How To Properly and Safely Inject Yourself for Life

Syringe, Needle Gauge, and Withdrawing

Where To Inject The Needle, and How to Inject Yourself Safely

TOT Via Subcutaneous Administration

Needle Disposal

Minimizing Scar Tissue Formation with Foam Rolling and Myofascial Release

Key Takeaways

Chapter 10 – Potential Side Effects, Their Likelihood, and How to Alleviate Them

Estradiol (E2)


Baldness and Acne


SERM’s (Selective Estrogen Receptor Modulators) and AIs (Aromatase Inhibitors) to Treat Side


The Usage of AIs and SERM’s as TOT

Metabolic Syndrome, Obesity, Insulin Resistance, Aromatase and Estrogen

Key Takeaways

Chapter 11 – Eliminating Gynecomastia Permanently

Types of Gynecomastia

Option 1 – Conceal/Avoid

Option 2 – Lose Fat, Build Muscle, & Balance Hormones through TOT

Option 3 – Surgical Removal

Key Takeaways

Chapter 12 – Monitoring TOT for Optimum Health

Understanding Your Blood Panels

BioMarker Cheat Sheet

Evaluating Blood Testosterone

The Importance of Sex Hormone Binding Globulin (SHBG)

Hematocrit and Hemoglobin

Liver Health

PSA (Prostate-Specific Antigen) & Prostate Health

Blood Pressure

Sleep Apnea and TOT

Heart and Vascular Health

Lipids (Blood Fats) and Cholesterol Health


Testicular Shrinkage, Low Sperm Count and HPTA/HPGA Dysfunction

The Myth of Penis Shrinking

Why Cycling Testosterone is a Myth

Key Takeaways

Chapter 13 – The Critical Role of Nutrition in TOT

Your Caloric Intake is Dependent on Your Physical Goals

The Specific Macronutrients Needed on Your TOT Nutrition Plan

Vitamin & Mineral Supplementation to Maximize TOT

What to Minimize and Avoid While on TOT

Proper Hydration – How Much Water is Enough?

The Importance of Vitamin D from Sunlight and Supplementation

Key Takeaways

Chapter 14 – What is Insulin-Controlled Living, and Why Is it Essential?

How Insulin Works

Insulin and Glucose Utilization

Insulin Resistance

Major Myth of “Insulin Hypothesis”

How Do You Manage Your Insulin?

Good Carbs vs Bad Carbs

Optimal Versus Suboptimal Carbohydrate Consumption

Overall Plan of Attack

Key Takeaways

Chapter 15 – Agents of Change





Citrulline Malate


Desiccated Thyroid

Energy Memory Focus (EMF) (OTC Nootropic)

Human Growth Hormone (HGH)


Ipamorelin for Women

Melanotan I and Melanotan II





Thymosin Beta-4

Future Agents of Change

Key Takeaways

Chapter 16 – TOT and Fitness

The Foundational Role of Weight Training

Building Muscle and Strength

The Cardio Equation – How Much and What Kind?

The Importance of Sleep

Dealing with Injuries

Spiritual Fitness

Key Takeaways

Bonus Chapter 17 -The State of the Science in Male Hormonal Optimization: Interview with Dr.

Rob Kominiarek

Key Takeaways

Bonus Chapter 18 – Hormonal Optimization Therapy (HOT) for Women: Doing it the Right Way

Female Health is Neglected

Hormone Deficiencies are a Disease at Any Age

Hormone Deficiencies are a Health Priority

Birth Control is NOT Hormone Restoration:

Pre- and Perimenopause

Key Principles in Female Hormone Optimization Therapy (HOT)

Applying the Key Principles

Key Takeaways

Bonus Chapter 19 – The Stone Cold Truth about Anabolic and Androgenic Steroids (AAS)

Don’t Ask About Steroids Until You Understand Steroids

A Brief Mention of AAS Drugs (Most Popular Synthetics)

Do Anabolic Steroids Work?

The Biological Differences Between Testosterone in Men and Women

Does TOT Count As Steroids?

Difference Between TOT and AAS

Potential Negative Side Effects

The Effects of AAS on Mood

What About the Increased Strength and Size?

How Much Expected Muscle Gain?

The Downside to Taking Steroids

Putting Pro Bodybuilding History Into Perspective

Key Takeaways

Bonus Chapter 20 – TOT and US Military Veterans: The Problem and Solution

Tales From the Blast Factory: A Veteran’s Story

Testosterone and the Road to Recovery

Looking After Our Veterans


Getting Treated

Out with the Old and In with the New

Key Takeaways

Chapter 21 – Conclusion

The Golden Rules

Frequently Asked Questions

TOT Resources

About the Authors

The Science Team

The Editing Team

A Sincere Request

Testosterone Optimization Therapy

Testosterone replacement therapy (TRT) has surged in popularity over the past decade. Millions of older men have turned to TRT to restore hormone levels in hopes of refueling energy and reigniting their sex drive.
Yet TRT remains controversial because of its uncertain benefits and potential health risks. Safety concerns were raised years ago when studies showed a possible association between TRT and an increased risk of cardiovascular disease.

Dr. Frances Hayes, a reproductive endocrinologist with Harvard-affiliated Massachusetts General Hospital, points out that some of these studies had limitations.

“For instance, in one study, TRT doses were much higher than what would usually be prescribed, and the subjects tended to be more frail, with other health problems,” she says. “Other studies showed no evidence of increased risk.”

The latest findings

Recent research has supported this position. A study reported at the 2015 American Heart Association Scientific Sessions involved 1,472 men ages 52 to 63 with low testosterone levels and no history of heart disease. Researchers found that healthy men who received TRT did not have a higher risk of heart attack, stroke, or death.

Furthermore, a study in the August 2015 Mayo Clinic Proceedings showed no link between TRT and blood clots in veins among 30,000 men. “Right now, the jury is still out about TRT’s influence on cardiovascular disease,” says Dr. Hayes.

TRT’s relationship with other health issues is also mixed. For instance, TRT has previously been tied to a higher incidence of prostate cancer, but a study published in the December 2015 Journal of Urology found that exposure to TRT over a five-year period was not linked to a greater risk of aggressive prostate cancer.
The bottom line is that the long-term risks of TRT are still unknown, as many of these studies have limited follow-ups. That does not mean you should avoid TRT. For a selected subgroup of men, the therapy can be a viable option.

Who is a candidate?

You need to have both low levels of testosterone—less than 300 nanograms per deciliter (ng/dL)—and several symptoms (see page 7) to get a prescription for TRT. “It is possible to have low levels and not experience symptoms,” says Dr. Hayes. “But if you do not have any of the key symptoms, especially fatigue and sexual dysfunction, which are the most common, it is not recommended you go on TRT given the current uncertainty with regard to long-term safety.”

A simple blood test measures testosterone levels. Several tests are required, as levels can fluctuate daily and be influenced by medication and diet. “In 30% of cases where the first testosterone test is low, levels are normal when the test is repeated,” says Dr. Hayes.

Even if your levels are low and you have several symptoms, TRT is not always the first course of action. “If you can identify the source for declining levels, often you can address that problem and increase low levels naturally,” says Dr. Hayes.

For instance, the No. 1 contributor to falling levels is weight gain. “Weight has a bigger impact on testosterone levels than aging. As weight goes up, testosterone levels go down,” she says. A five-point increase on the body mass index scale—for instance, going from 30 to 35—is equivalent to adding 10 years to your age in terms of testosterone levels.

“Your doctor should also review any other factors that might influence levels, like medication or medical conditions,” says Dr. Hayes. In these instances, your doctor may treat the underlying condition or change your medication or dosage to one that would not affect testosterone levels.

Men also need to understand the limits of TRT, as many envision it as a type of fountain of youth. “Its impact is less than what many men would expect,” says Dr. Hayes.

For example, two often-touted benefits of TRT are sexual health and vitality. A double-blind study in the Feb. 18, 2016 issue of The New England Journal of Medicine reviewed the effects of TRT on 790 men ages 65 and older. Those who received TRT for one year, versus those on placebo, saw improvements in sexual function, including activity, desire, and erectile function. However, the group experienced only a slight improvement in mood and saw no changes in walking speed, which was used to measure TRT’s effect on vitality.

Using TRT

TRT is often given by either gel application or injection. With a gel, you spread the daily dose—often the size of a ketchup package—over both upper arms, shoulders, or thighs. Injections are typically given into the buttocks once every two weeks.

Each method has its advantages. With gels, there is less variability in levels of testosterone. “However, you have to be careful to avoid close skin contact for a few hours, especially with women, as the testosterone could cause acne or hair growth,” says Dr. Hayes.

With injections, testosterone levels can rise to high levels for a few days after the injection and then slowly come down. This can cause a roller-coaster effect, where mood and energy levels spike before trailing off.
Most men feel improvement in symptoms within four to six weeks, although changes like increases in muscle mass may take from three to six months.



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